title: Learning curve for radical retropubic prostatectomy.
abstract: OBJECTIVE
  The learning curve is a period in which the surgical procedure is performed with difficulty and slowness, leading to a higher risk of complications and reduced effectiveness due the surgeon's inexperience. We sought to analyze the residents' learning curve for open radical prostatectomy (RP) in a training program.
  
  
  METHODS
  We conducted a prospective study from June 2006 to January 2008 in the academic environment of the University of Sao Paulo. Five residents operated on 184 patients during a four-month rotation in the urologic oncology division, mentored by the same physician assistants. We performed sequential analyses according to the number of surgeries, as follows: ≤ 10, 11 to 19, 20 to 28, and ≥ 29.
  
  
  RESULTS
  The residents performed an average of 37 RP each. The average psa was 9.3 ng/mL and clinical stage T1c in 71% of the patients. The pathological stage was pT2 (73%), pT3 (23%), pT4 (4%), and 46% of the patients had a Gleason score 7 or higher. In all surgeries, the average operative time and estimated blood loss was 140 minutes and 488 mL. Overall, 7.2% of patients required blood transfusion, and 23% had positive surgical margins.
  
  
  CONCLUSIONS
  During the initial RP learning curve, we found a significant reduction in the operative time; blood transfusion during the procedures and positive surgical margin rate were stable in our series.
authors.affiliation: Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Fernando J A
authors.initials: FJ
authors.lastname: Saito
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Dall'Oglio
authors.forename: Gustavo X
authors.initials: GX
authors.lastname: Ebaid
authors.forename: Homero
authors.initials: H
authors.lastname: Bruschini
authors.forename: Daher C
authors.initials: DC
authors.lastname: Chade
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency; D007431:Intraoperative Complications; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D011468:Prostatectomy / Q000193:education*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome